Summary

There are very few level 1 or level 2 evidence studies that examine postoperative
rehabilitation of rotator cuff repair and shoulder arthroplasty. A systematic review of
level 1 or level 2 evidence studies was performed (Baumgarten et al., Sports Health, 2009)
that found only four studies that examined rotator cuff repair rehabilitation.

The current study was performed to determine if there is a significant difference in passive
glenohumeral joint range of motion, active glenohumeral joint range of motion, scapular
substitution, and subjects measured outcome scores (clinimetrics) in patients who undergo
rotator cuff repair when treated postoperatively with pulley exercises compared to Jackins'
exercises.

Null Hypothesis: There will be no significant difference in passive range of motion, active
range of motion, scapular substitution, and subject measured outcomes scores in subjects who
undergo rotator cuff repair when treated with pulley exercises compared to Jackins'
exercises.

Jackin's exercises were initially designed for patients with difficulty performing forward elevation. The patient initially is positioned supine to perform shoulder flexion. When the patient can actively elevate in the supine position, one to two pounds of weight is placed in the patients hand and the patient is asked to repeat the maneuver of supine active elevation. When the patient can do this with little difficulty, the head of the bed is elevated approximately 20 degrees from the supine position and the sequence is repeated. Once the patient is able to perform flexion in this elevated head position, the inclination of the patient is increased in 20 degree increments until the patient is able to perform upright sitting shoulder flexion.

postoperative jackins exercise protocol

Jackin's exercises were initially designed for patients with difficulty performing forward elevation. The patient initially is positioned supine to perform shoulder flexion. When the patient can actively elevate in the supine position, one to two pounds of weight is placed in the patients hand and the patient is asked to repeat the maneuver of supine active elevation. When the patient can do this with little difficulty, the head of the bed is elevated approximately 20 degrees from the supine position and the sequence is repeated. Once the patient is able to perform flexion in this elevated head position, the inclination of the patient is increased in 20 degree increments until the patient is able to perform upright sitting shoulder flexion.

Pulleys have been used in postoperative shoulder rehabilitation to improve passive as well as active range of motion and develop strength.

postoperative pulleys exercise protocol

Pulleys have been used in postoperative shoulder rehabilitation to improve passive as well as active range of motion and develop strength.

Primary Outcomes

Measure

Change in Western Ontario Rotator Cuff Index (WORC)

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Secondary Outcomes

Measure

Change in scapular substitution (centimeters)

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in range of motion (degrees)

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in strength (N)

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in Simple Shoulder Test9

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in American Shoulder and Elbow Surgeon (ASES) Shoulder Score

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in Marx Shoulder Activity Score2

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Change in Single Assessment Numeric Evaluation (SANE) rating

time frame:
Baseline, 6 weeks, 12 weeks, 6 months, 1 year

Eligibility Criteria

Male or female participants at least 18 years old.

Inclusion Criteria:
- Patients undergoing post-operative rehabilitation for a rotator cuff repair
Exclusion Criteria:
- Patients who do not have permission from their treating surgeon to enroll in this
study.
Patients who have undergone a previous rotator cuff repair on the non-operated side.
Patients who have undergone a previous rotator cuff repair on the ipsilateral shoulder.
Patients who have a history of adhesive capsulitis. Patients who are unwilling to
participate in all aspects of the study. Patients who are cognitively impaired. Patients
with known axillary or suprascapular neuropathy. Patients with a painful or dysfunctional
contralateral shoulder.

Additional Information

Scapulothoracic substitution for forward elevation is seen clinically when patients have
shoulder pain. The patient uses the trapezius musculature to superiorly elevate the upper
extremity instead of using the deltoid and the rotator cuff for upper extremity elevation.
Scapulothoracic substitution does not occur in healthy shoulders. Excessive scapular
movement can be due to an attempt to substitute for poorly functioning shoulder musculature
or tightness of the capsular structures of the glenohumeral joint.
Pulleys have been used in postoperative shoulder rehabilitation to improve passive as well
as active range of motion and develop strength. Jackins described a series of exercises
that are used to improve active range of motion and develop strength without the use of
pulleys. The use of pulleys in the post-operative care for patients who have had shoulder
surgery is thought to contribute to excessive scapular motion. To date, there has not been
any study that compares the use of pulleys and Jackins' exercises with respect to active
range of motion, scapulothoracic substitution, and objective patient outcomes measures. Due
to the lack of level 1 or 2 evidence postoperative rehabilitation studies, a prospective
randomized study should be performed on patients that have underwent rotator cuff repair.

Trial information was received from ClinicalTrials.gov and was last updated in March 2013.